Chapter 48: Nursing Care of the Child With an Alteration in Metabolism/Endocrine Disorder
The nurse measures the client's blood glucose level prior to breakfast. The measurement obtained is 130 mg/dl. The orders read to administer 2 units of Humalog insulin for a blood glucose of 100 to 150 mg/dl. How soon should the nurse ensure that the client eats breakfast after receiving insulin? within 5 minutes within 15 to 30 minutes within 60 to 90 minutes within 2 hours
within 15 to 30 minutes Explanation: Humalog is a rapid-acting insulin. The onset of Humalog insulin is within 15 minutes and the peak level is achieved within 30 to 90 minutes; therefore, the client should eat within 15 to 30 minutes to avoid a hypoglycemic reaction.
A nurse is reviewing the blood sugar test results of a child diagnosed with type 1 diabetes: Before meal: 84 mg/dL (4.66 mmol/l) 1 hour after meal: 160 mg/dL (8.88 mmol/l) 2 hours after meal: 180 mg/dL (9.99 mmol/l) Middle of the night: 92 mg/dL (5.11 mmol/l) Which result would lead the nurse to notify the health care provider? before meal 1 hour after meal 2 hours after meal middle of the night
2 hours after meal Explanation: Acceptable blood glucose levels for a child 2 hours after a meal would range from 80 to 150 mg/dL (4.44 to 8.32 mmol/l).
A 15-year-old adolescent is scheduled for a pelvic ultrasound to evaluate for a possible ovarian cyst. Which instruction by the nurse would be most appropriate? "Drink plenty of fluids because you need to have a full bladder." "You need to remain very still for the entire test." "You won't be able to drink any water before or during the test." "Limit your level of physical activity for one-half hour before the test."
"Drink plenty of fluids because you need to have a full bladder." Explanation: A full bladder is needed for an ultrasound of the pelvic region.
When discussing care of an infant with congenital hypothyroidism, you would stress that the infant will need: administration of vitamin C until after growth is complete. an increased intake of calcium beginning in infancy. administration of levothyroxine for a lifetime. vitamin K administration until school age.
administration of levothyroxine for a lifetime. Explanation: Hypothyroidism occurs because the thyroid is not producing adequate thyroxine. The child will need a supplemental source for a lifetime.
Diabetes insipidus is a disorder of the posterior pituitary resulting in deficient secretion of which hormone? antidiuretic hormone adrenocorticotropic hormone thyroid stimulating hormone luteinizing hormone
antidiuretic hormone Explanation: Central diabetes insipidus (DI), also called neurogenic, vasopressin-sensitive, or hypothalamic DI, is a disorder of the posterior pituitary that results from deficient secretion of ADH.
The nurse knows that which condition is caused by excessive levels of circulating cortisol? Addison disease Graves disease Turner syndrome Cushing syndrome
Cushing syndrome Explanation: Cushing syndrome is a characteristic cluster of signs and symptoms resulting from excessive levels of circulating cortisol.
A pediatric nurse is discharging a 1-month-old infant. The infant was diagnosed with congenital hypothyroidism on this admission and will be treated with levothyroxine. The nurse knows it is important to teach the parent about medication administration. Which process will the nurse include in the teaching? Give the crushed medication in a syringe mixed with a small amount of formula. Crush the medication and put it in the full bottle of formula so it tastes better. Administer the medication every other day. Explain that this treatment is administered until the child is 3 years of age.
Give the crushed medication in a syringe mixed with a small amount of formula. Explanation: The medication should be mixed in a small amount of food to make sure the infant receives the whole dose.
An elementary school child takes metformin three times each day. Which disorder would the school nurse expect the child to have? Type 1 diabetes mellitus Gastrointestinal reflux Inflammatory bowel disorder Type 2 diabetes mellitus
Type 2 diabetes mellitus Explanation: Metformin is the common treatment to manage type 2 DM. Insulin, not oral medication, is the treatment of choice for type 1 DM.
The nurse knows that disorders of the pituitary gland depend on the location of the physiologic abnormality. In caring for a child that has issues with the anterior pituitary, the nurse knows that this child has issues with which hormone? vasopressin antidiuretic hormone oxytocin growth hormone
growth hormone Explanation: Disorders of the pituitary gland depend on the location of the physiologic abnormality. The anterior pituitary, or adenohypophysis, is made up of endocrine glandular tissue and secretes growth hormone (GH), adrenocorticotropic hormone (ACTH), TSH, follicle-stimulating hormone (FSH), luteinizing hormone (LH), and prolactin.
A child is diagnosed with hypoparathyroidism. Which electrolyte imbalance would the nurse most likely expect to address? hypocalcemia hyperkalemia hyponatremia hypomagnesemia
hypocalcemia Explanation: Hypoparathyroidism results in low production of PTH, which in turn leads to hypocalcemia and hyperphosphatemia.
The nurse is interpreting the negative feedback system that controls endocrine function. What secretion will the nurse correlate as decreasing while blood glucose levels decrease? glucagon adrenocorticotropic hormone insulin glycogen
insulin Explanation: Feedback is seen in endocrine systems that regulate concentrations of blood components such as glucose. Glucose from the ingested lactose or sucrose is absorbed in the intestine and the level of glucose in blood rises. Elevation of blood glucose concentration stimulates endocrine cells in the pancreas to release insulin. Insulin has the major effect of facilitating entry of glucose into many cells of the body; as a result, blood glucose levels fall. When the level of blood glucose falls sufficiently, the stimulus for insulin release disappears and insulin is no longer secreted.
A nurse is teaching an adolescent with type 1 diabetes about the disease. Which instruction by the nurse about how to prevent hypoglycemia would be most appropriate for the adolescent? "Limit participation in planned exercise activities that involve competition." "Carry crackers or fruit to eat before or during periods of increased activity." "Increase the insulin dosage before planned or unplanned strenuous exercise." "Check your blood glucose level before exercising, and eat a protein snack if the level is elevated."
"Carry crackers or fruit to eat before or during periods of increased activity." Explanation: Hypoglycemia can usually be prevented if an adolescent with diabetes eats more food before or during exercise. Because exercise with adolescents isn't commonly planned, carrying additional carbohydrate foods is a good preventive measure.
The nurse is teaching glucose monitoring and insulin administration to a child with type 1 diabetes and the parents. Which comment by a parent demonstrates a need for additional teaching? "During exercise we should wait to check blood sugars until after our child completes the activity." "If our child is sick we should check blood glucose levels more often." "We should check our child's blood glucose levels before meals." "Blood glucose level, food intake, and activity need to all be considered when calculating insulin dosage."
"During exercise we should wait to check blood sugars until after our child completes the activity." Explanation: Blood glucose monitoring needs to be performed more often during prolonged exercise. Frequent glucose monitoring before, during, and after exercise is important to recognize hypoglycemia or hyperglycemia.
A nurse who is caring for a 7-year-old is providing client education to the child and caregiver. Which response by the caregiver demonstrates to the nurse that the caregiver understands the diagnosis of type 1 diabetes mellitus? "We will just have our child exercise and take medicine to cure this." "I will just feed my child healthy foods and sign her up for more sports." "Her body fights against the insulin." "Her body doesn't have any insulin."
"Her body doesn't have any insulin." Explanation: Type 1 diabetes mellitus (DM) is a disorder in which the child's body has a deficiency of insulin; children with type 1 DM cannot produce insulin.
The nurse is teaching a group of caregivers of children diagnosed with diabetes. The nurse is explaining insulin shock and the caregivers make the following statements. Which statement indicates the best understanding of a reason an insulin reaction might occur? "If my child eats as much as their older brother eats they could have an insulin reaction." "My child measures their own medication but sometimes doesn't administer the correct amount." "My child monitors their glucose levels to keep them from going too high." "On the weekends we encourage our child to participate in lots of sports activities and stay busy so they don't have an insulin reaction."
"My child measures their own medication but sometimes doesn't administer the correct amount." Explanation: Insulin reaction (insulin shock, hypoglycemia) is caused by insulin overload, resulting in too-rapid metabolism of the body's glucose. This may be attributable to a change in the body's requirement, carelessness in diet (such as failure to eat proper amounts of food), an error in insulin measurement, or excessive exercise.
A 13-year-old adolescent with hyperthyroidism who takes antithyroid medication has a sore throat and a fever. The parent calls the nurse and asks what to do. Which is the best response from the nurse? "Please take your child straight to the emergency department." "Fever and sore throat may be side effects of the medication." "Give your child ibuprofen according to the instructions on the box." "Offer your child at least 8 ounces of clear fluids and call back tomorrow."
"Please take your child straight to the emergency department." Explanation: A side effect of antithyroid medications is leukopenia. Signs and symptoms that include fever and sore throat need to be seen immediately.
A nurse is reinforcing the diagnosis of constitutional delay by the health provider to a 13-year-old male adolescent. Which is the best approach for this teen? "I would be worried about your short stature too and get a second opinion." "You will not need medication because your hormone levels are normal. I would be glad to discuss these findings with you." "If you think you want testosterone shots, then I will get them scheduled for you." "It really doesn't matter how tall your dad is. The physician just looks at your height to make this diagnosis."
"You will not need medication because your hormone levels are normal. I would be glad to discuss these findings with you." Explanation: This diagnosis of "short stature" or constitutional delay may cause self-esteem issues with male teens. The nurse should explore the teen's feelings.
A nurse should recognize that which laboratory result would be most consistent with a diagnosis of diabetes mellitus? proteinuria a fasting blood glucose less than 126 mg/dl a fasting blood glucose greater than 126 mg/dl glucose in the urine
A fasting blood glucose greater than 126 mg/dl is diagnostic for diabetes mellitus.
The nurse is caring for a 14-year-old boy with hyperpituitarism. What would be the priority treatment? Administering octreotide acetate as ordered Assessing the child's self-image due to the disorder Treating the child according to his chronological age Teaching the child and family about proper treatment
Administering octreotide acetate as ordered Explanation: Administering octreotide acetate as ordered is the priority intervention and treatment for acromegaly.
The parents of a child who was diagnosed with diabetes insipidus ask the nurse, "How does this disorder occur?" When responding to the parents, the nurse integrates knowledge that a deficiency of which hormone is involved? Antidiuretic hormone Growth hormone Insulin Thyroxine
Antidiuretic hormone Explanation: Diabetes insipidus results from a deficiency in the secretion of antidiuretic hormone (ADH). This hormone, also known as vasopressin, is produced in the hypothalamus and stored in the pituitary gland
A nurse is reviewing with an 8-year-old how to self-administer insulin. Which of the following is the proper injection technique for insulin injections? Place the needle with the bevel facing down before the injection. Spread the skin before the injection. Aspirate the syringe for blood return before the injection. Elevate the subcutaneous tissue before the injection.
Elevate the subcutaneous tissue before the injection. Explanation: Insulin injections are always given subcutaneously. Elevating the skin tissue prevents injection into muscles when subcutaneous injections are given.
A child is admitted to the pediatric medical unit with the diagnosis of syndrome of inappropriate antidiuretic hormone (SIADH). Based on the typical signs and symptoms of this disorder, which nursing diagnosis will the nurse identify as relating to this client? Delayed growth and development Imbalanced nutrition: More than body requirements Noncompliance Excess fluid volume
Excess fluid volume Explanation: Syndrome of inappropriate antidiuretic hormone (SIADH) occurs when ADH (vasopressin) is secreted in the presence of low serum osmolality because the feedback mechanism that regulates ADH does not function properly. ADH continues to be released, and this leads to water retention, decreased serum sodium due to hemodilution, and extracellular fluid volume expansion; thus, Excess fluid volume from edema is the highest priority.
A child is diagnosed with hyperthyroidism. What finding would the nurse expect to assess? Heat intolerance Constipation Weight gain Facial edema
Heat intolerance Explanation: Hyperthyroidism is manifested by heat intolerance, nervousness or anxiety, diarrhea, weight loss, and smooth velvety skin.
A 12-year-old child suddenly experiences an extreme drop in blood pressure following discontinuation of prednisone. The child appears gray and has a weak pulse. Which is the priority nursing intervention in this situation? Immediate replacement of cortisol Cardiopulmonary resuscitation Administration of insulin Administration of epinephrine
Immediate replacement of cortisol Explanation: Insufficiency (hypofunction) of the adrenal gland can occur when corticosteroid therapy such as prednisone that has been maintained at high levels for long periods is abruptly stopped and the gland does not return to usual function. With acute adrenocortical insufficiency, the blood pressure drops to extremely low levels; the child appears ashen gray and the pulse is weak. . Temperature gradually becomes elevated; dehydration and hypoglycemia (an abnormally low concentration of blood glucose) become marked as cortisol is no longer present to regulate this. It is a medical emergency, and treatment involves the immediate replacement of cortisol
Which results would indicate to the nurse the possibility that a neonate has congenital hypothyroidism? High thyroxine (T4) level and low thyroid stimulating hormone (TSH) level Low T4 level and high TSH level Normal TSH level and high T4 level Normal T4 level and low TSH level
Low T4 level and high TSH level Explanation: Screening results that show a low T4 level and a high TSH level indicate congenital hypothyroidism and the need for further tests to determine the cause of the disease.
The nurse is caring for a 4-year-old boy during a growth hormone stimulation test. Which task is priority in the care of this child? Providing a wet washcloth to suck. Educating family about side effects. Monitoring blood glucose levels. Monitoring intake and output.
Monitoring blood glucose levels. Explanation: Monitoring blood glucose levels during this study is the priority task along with observing for signs of hypoglycemia since insulin is given during the test to stimulate release of growth hormone.
The nurse is caring for a child who is scheduled for bone scan. It is suspected that the child has a growth hormone deficiency. Which finding would support this medical diagnosis? The bone scan would show bone age to be two or more deviations below normal. The bone scan would show a brain tumor. The bone scan would show bone age to be three or more deviations above normal. The bone scan would show a tumor on the child's kidney.
The bone scan would show bone age to be two or more deviations below normal. Explanation: Diagnostic testing used in children with suspected GH deficiency would indicate bone age to be two or more deviations below normal.
A 6-year-old boy has a moon-face, stocky appearance but with thin arms and legs. His cheeks are unusually ruddy. He is diagnosed with Cushing syndrome. What is the most likely cause of this condition in this child? Tumor of the adrenal cortex Tumor of the thyroid Tumor of the pancreas Tumor of the parathyroid
Tumor of the adrenal cortex Explanation: Cushing syndrome is caused by overproduction of the adrenal hormone cortisol; this usually results from increased ACTH production due to either a pituitary or adrenal cortex tumor.
A nurse is educating the family of a small child with phenylketonuria about meal choices. Which meal choice by the parents indicates to the nurse that they understand the dietary management of this disease? a milkshake and a grilled cheese sandwich a bowl of dry cereal with strawberries and apple juice a steak, mashed potatoes, and orange juice a hamburger and a diet soda sweetened with aspartame
a bowl of dry cereal with strawberries and apple juice Explanation: The nurse is able to evaluate parental understanding of meal choices by having the parent select appropriate meals. The nurse confirms understanding when the parent selects foods low in phenylalanine, which include vegetables, fruits, juices, some breads, and some cereals.
The nurse is assessing a 5-year-old child whose parent reports the child has been vomiting lately, has no appetite, and has had an extreme thirst. Laboratory work for diabetes is being completed. Which symptom would differentiate between type 1 diabetes from type 2 diabetes? recent weight loss blood pressure of 142/92 mm Hg slow healing wounds loose stools
recent weight loss Explanation: Weight loss is unique to type 1 diabetes, whereas weight gain is associated with type 2.
A 10-year-old child is newly diagnosed with type 1 diabetes. The child's hemoglobin A1C level is being monitored. The nurse determines that additional intervention is needed with the child based on which result? 8.5% 6.5% 7.5 % 7.0%
The goal for hemoglobin A1C in children between the ages of 6 and 12 years is less than 8%. Therefore, a result of 8.5% would indicate that additional intervention is needed to achieve the recommended goal.
After teaching the parents of a child with central precocious puberty about medication therapy, which statement by the parents indicates successful teaching? "Our child needs to use the nasal spray once every day." "Our child will start puberty again when the medication stops." "This medicine will reverse the symptoms and onset of puberty." "Once therapy is done, our child will need surgery."
"Our child will start puberty again when the medication stops." Explanation: Treatment for central precocious puberty involves administering a gonadotropin-releasing hormone (GnRH) analog. When it is stopped, puberty resumes according to the appropriate developmental stages.
The nurse is assessing a child diagnosed with Cushing disease. Which statement by the parents demonstrates a need for further teaching? "We need to pay close attention to any wounds our child gets to monitor for adequate healing." "My child may experience excessive hair growth and rapid weight gain." "This disorder is most likely due to an infection my child had recently." "My child's round, full face appearance is reversible with appropriate treatment."
"This disorder is most likely due to an infection my child had recently." The most common cause of Cushing disease is long-term corticosteroid therapy or a pituitary adenoma, not an infection.
The nurse is taking a history on a 10-year-old child who has a diagnosis of hypopituitarism. Which question is important for the nurse to ask the parents? "Is your child taking vasopressin IM or SC?" "What time each day does your child take his growth hormone?" "Does your child get upset about being taller than friends?" "How often do you test your child's blood glucose?"
"What time each day does your child take his growth hormone?" Explanation: It is important for the nurse to know the time of day that the child takes his or her growth hormone.
A child is brought to the clinic experiencing symptoms of nervousness, tremors, fatigue, increased heart rate and blood pressure. Based on this assessment, the nurse would suspect a diagnosis of which condition? hypertension Graves disease Cushing syndrome hypothyroidism
Graves disease Explanation: Children who develop Graves disease experience nervousness, tremors, and increased heart rate and blood pressure cause by overstimulation of the thyroid gland.
A 10-year-old child has been diagnosed with type 1 diabetes. The child is curious about the cause of the disease and asks the nurse to explain it. Which explanation will the nurse provide? "Special cells in a part of your body called the pancreas cannot make a chemical called insulin, which helps control the sugar level in your blood." "The pancreas inside your belly makes enough chemical called insulin, but your body does not want to use it to keep your blood sugar level normal." "The part of your body called the pancreas is broken and produces too much chemical called glucagon, which makes you really thirsty and have to go to the bathroom a lot." "The alpha and beta cells in your pancreas are fighting against each other; that is why your blood sugar stays high and you need insulin injection."
"Special cells in a part of your body called the pancreas cannot make a chemical called insulin, which helps control the sugar level in your blood." Explanation: When providing instruction to a child, the nurse must consider the developmental age. Type 1 diabetes is a disorder that involves an absolute or relative deficiency of insulin, thus the blood glucose level remains high if an appropriate amount of insulin is not administered to the client.
A 10-year-old client is upset and tells the school nurse. "I am the shortest one in my class. I am done with school and just want to stay home." Which response by the nurse is most appropriate? "Let me explain to you your disorder so you understand what is going on." "I know kids can be mean these days, but I am sure you will be taller soon." "You seem very upset. Sit down and let's talk about what is going on." "Would you like to talk with another child who has experienced what you are going through?"
"You seem very upset. Sit down and let's talk about what is going on." Explanation: The child is voicing feelings of personal devaluation. This is consistent with a lack of self-esteem and the nurse needs to first acknowledge and then talk to the client about the feelings.
The nurse is caring for a newborn with 21-OH enzyme deficiency congenital adrenal hyperplasia (CAH). The nurse identifies one goal of the plan of care as being the understanding of the importance of maintaining hormone supplementation. Which outcome criteron demonstrates this goal has been met? During follow-up visits the child demonstrates normal growth and development. Prior to discharge the parents state that they understand the medication regimen. The parents fill the prescription for hormone replacement therapy prior to discharge. The parents ask appropriate questions about the planned treatment goals.
During follow-up visits the child demonstrates normal growth and development. Explanation: 21-OH enzyme deficiency results in blocking the production of adrenal mineralocorticoids and glucocorticoids. Improvement of symptoms, such as normal growth and development, is the best indicator that the goal of hormone replacement therapy is being carried out as ordered.
A nurse is taking care of an infant with diabetes insipidus. Which assessment data are most important for the nurse to monitor while the infant has a prescription for fluid restriction? Vital signs Oral intake Oral mucosa Urine output
Urine output Explanation: An infant with the diagnosis of diabetes insipidus has decreased secretion of antidiuretic hormone (ADH). The infant is at risk for dehydration so monitoring urinary output is the most important intervention.
A 7-year-old child is diagnosed as having type 1 diabetes. What is one of the first symptoms usually noticed by parents when this illness develops? loss of weight craving for sweets severe itching swelling of soft tissue
loss of weight Explanation: The classic signs of type 1 diabetes are polydipsia, polyuria, and polyphagia. With polyphagia, the child has an increased appetite and increased hunger, and the child eats all the time but is losing weight. This occurs because the lack of energy sugar supplies causes the muscle tissues and the fat stores to shrink. The lack of insulin also reduces the ability of the body's cells to use glucose. This leads to starvation of the cells. Loss of weight is an early symptom parents see first.
A nurse caring for a child with Graves disease is administering propylthiouracil (PTU). The child has been on this drug for a few weeks and now has sudden symptoms of a sore throat. What is the priority intervention for the nurse? Ask the child if there is a reason he or she does not want to go back to school. Hold the dose and call the health care provider. Offer throat lozenges to soothe the throat. Continue medication to relieve the signs of Graves disease.
Hold the dose and call the health care provider. Explanation: The severe sore throat could be a sign of leukopenia, which is a side effect of PTU. The medication should be held and the health care provider called. The medication dose may need to be adjusted
A 7-year-old child who has type 1 diabetes mellitus is at school reporting a headache and dizziness. The school nurse notices sweat on the child's face. What should the nurse do first? Give glucagon IM Offer the child 8 ounces of juice or soda Give rapid-acting insulin Offer the child 8 ounces of water
Offer the child 8 ounces of juice or soda Explanation: These are symptoms of hypoglycemia. Glucagon is given only for severe hypoglycemia. Juice or soda is the best choice to get the child an immediate source of carbohydrates.
The nurse is assessing an 8-year-old boy who is performing academically at a second-grade level. The mother reports that the boy states feeling weak and tired and has had a weight increase of 6 pounds (13.2 kg) in 3 months. Which additional data would fit with a possible diagnosis of hypothyroidism? The child states that the exam room is cold. Oral cavity assessment shows two of the 6-year molars. The mother reports that the boy is always thirsty. The child has a faint rash on the trunk of the body.
The child states that the exam room is cold. Explanation: Cold intolerance, manifested by the fact that the child was uncomfortably cold in the exam room, is a sign of hypothyroidism.
A nurse is making a home visit to a 12-year-old child with type 1 diabetes and is reviewing insulin administration. The nurse determines that the teaching was successful when the child performs which actions? Select all that apply. Draws up the short-acting insulin before the intermediate-acting insulin. Stores the insulin vial at room temperature. Gives the injection at a 45-degree angle. Shakes the bottle of intermediate-acting insulin to make sure is it uniform. Aspirates for a blood return before injecting the medication.
Draws up the short-acting insulin before the intermediate-acting insulin. Stores the insulin vial at room temperature. Gives the injection at a 45-degree angle. The child demonstrates appropriate technique by drawing up the short-acting insulin before the intermediate-acting insulin, stores the insulin at room temperature, and gives the injection at a 45-degree angle. The child should gently roll the bottle of insulin to ensure a uniform mixture and inject the insulin without aspirating.
A child with a suspected endocrine disorder is having a fluid deprivation study performed. Which nursing interventions should be included in the plan of care? Select all that apply. Perform the test as an overnight study. Monitor strict I & O. Assess vital signs every hour. Monitor the child's weight on admission and before discharge. Obtain urine specimens and serum studies as ordered.
Monitor strict I & O. Assess vital signs every hour. Obtain urine specimens and serum studies as ordered. Strict I & O must be monitored to prevent dehydration. Vital signs, especially blood pressure and pulse, should be monitored hourly to detect signs of hypotension or tachycardia. During the tests, urine is monitored for specific gravity and osmolality and serum studies are performed to monitor for sodium, antidiuretic hormone, osmolality, and hematocrit alterations as ordered. A fluid deprivation study should not be performed overnight because it can cause severe dehydration and result in central nervous system damage. The child's weight should be monitored more frequently than on admission and discharge to detect weight loss that may signify too much fluid loss.
A 12-year-old boy arrives at the emergency room experiencing nausea, vomiting, headache, and seizures. He is diagnosed with bacterial meningitis. Other findings include a decrease in urine production, hyponatremia, and water intoxication. Which pituitary gland disorder would be most associated with these symptoms? Syndrome of inappropriate antidiuretic hormone Diabetes insipidus Hyposecretion of somatotropin Hypersecretion of somatotropin
Syndrome of inappropriate antidiuretic hormone Explanation: Syndrome of inappropriate antidiuretic hormone (SIADH) is a rare condition in which there is overproduction of antidiuretic hormone by the posterior pituitary gland. This results in a decrease in urine production and water intoxication. As sodium levels fall in proportion to water, the child develops hyponatremia or a lowered sodium plasma level
A child with a history of diabetes insipidus has been taking vasopressin. The parents bring the child to the clinic for an evaluation. During the visit, the parents mention that it seems like their son is hardly urinating. The nurse suspects syndrome of inappropriate antidiuretic hormone. What findings would the nurse expect to find to help confirm this condition? Select all that apply. urine specific gravity 1.033 decreased serum sodium level serum osmolality 260 mOsm/kg (260 mmol/kg) decreased urine osmolality weight loss hypotension
urine specific gravity 1.033 decreased serum sodium level serum osmolality 260 mOsm/kg (260 mmol/kg) Explanation: Syndrome of inappropriate antidiuretic hormone (SIADH) is characterized by decreased urination, hyponatremia, serum osmolality less than 280 mOsm/kg (280 mmol/kg), urine specific gravity greater than 1.030, increased urine osmolality, fluid retention, weight gain, and hypertension.
A child and parents are being seen in the office after discharge from the hospital. The child was newly diagnosed with type 2 diabetes. When talking with the child and parents, which statement by the nurse would be most appropriate? "You are lucky that you did not have to learn how to give yourself a shot." "Young people can usually be managed with an oral agent, meal planning, and exercise." "This will rectify itself if you follow all of the doctor's directions." "A weight-loss program should be implemented and maintained."
"Young people can usually be managed with an oral agent, meal planning, and exercise."
A newborn is discovered to have congenital adrenogenital hyperplasia. What will the nurse most likely observe when assessing this client? Enlarged clitoris Divergent vision Small for gestational age Abnormal facial features
Enlarged clitoris Explanation: Congenital adrenal hyperplasia is a syndrome that is inherited as an autosomal recessive trait, which causes the adrenal glands to not be able to synthesize cortisol. Because the adrenal gland is unable to produce cortisol, the level of adrenocorticotropic hormone (ACTH) secreted by the pituitary in an attempt to stimulate the gland to increase function is increased. Although the adrenals enlarge under the effect of ACTH, they still cannot produce cortisol but rather overproduce androgen. Excessive androgen production during intrauterine life masculinizes the genital organs in a female fetus so that the clitoris is so enlarged it appears to be a penis.
The nurse is reviewing the recommended diet with the parents and child who was diagnosed with type 2 diabetes. The nurse determines that the parents and child understand the information when they identify that they will restrict carbohydrate intake to which amount at each of the three main meals? 45 grams 15 grams 30 grams 60 grams
Typically, carbohydrate intake is restricted to 45 grams at each of the three main meals of the day.
A female adolescent comes to the clinic with symptoms of delayed puberty. The nurse discusses sexual development with the adolescent, the beginning of menstruation, and how to take the low-dose estrogen product. What additional topic is most important for the nurse to discuss with the adolescent? risk for infertility side effects of the medication to report peer pressure at school signs of the first menstrual period
risk for infertility Explanation: Delayed puberty is a condition of delayed secondary sexual development. In girls, it exists if the breasts have not developed by age 12, pubic hair has not appeared by age 14 or menarche has not occurred by age 16. The most common cause is what is known as "constitutional delay." This is a family pattern. The child will develop normally, just at later stages than normal. Delayed puberty can also be caused by genetic conditions, radiation, anorexia, and cystic fibrosis. In girls, the treatment is the administration of estradiol-conjugated estrogen in low doses. It is very important for the nurse to answer all questions and concerns of the adolescent. One major concern is always the topic of infertility, as it is a permanent condition. The possibility of infertility is related to the cause of the delayed puberty. If the cause is radiation or a genetic disorder, the chance is likely to be high.
